Suture button construct for surgical procedures

ABSTRACT

A suture button for a surgical procedure provides an anchor for pulling and maintaining suture tension through a transosseous tunnel during an operation such as meniscal root repair in the knee. The suture button includes a body having a first tapered longitudinal end, a second tapered longitudinal end, a first side, a second side, an anterior surface and a posterior surface. A first concave notch is defined in the first side, and a second concave notch is defined in the second side. The first notch is open to a first suture dock in the first side, and the second notch is open to a second suture dock in the second side. Each of the first and second suture docks includes a seat to centrally position suture material. A center passage is defined through the suture body at a location between the first and second suture docks.

BACKGROUND

The present invention relates generally to devices and methods forperforming arthroscopic surgery on joints and more particularly tosuture button devices and associated methods for anchoring andtensioning of sutures during and after surgery.

Various types of sutures, suture fixation devices and associated methodsare known in the art for securing a suture in a desired position and/orat a desired tension during and after surgical procedures. In manysurgical procedures, a transosseous hole is drilled through a portion ofbone, forming a rigid tunnel for passing a surgical instrument or asuture. The drilled tunnel includes a proximal opening adjacent a tissuerepair site where a procedure for the repair of tissue is generallyperformed, such as but not limited to a procedure to repair a meniscusroot tear in a knee. The drilled tunnel generally also includes a distalopening at a location remote from the repair site.

During such procedures, one or more sutures are attached to the tissueto be repaired. A free end of the suture is then inserted through theproximal opening of the drilled tunnel and passed away from the repairsite to the distal tunnel opening. The suture then exits the distal endof the tunnel and is tensioned to manipulate the damaged tissue into adesired position. The free end of the suture extending out of the distaltunnel opening must be pulled tight to maintain tension on the tissuefollowing the operation. After tension is applied, the suture is fixedin place using an anchor to maintain the desired tension.

Numerous types of suture buttons and suture anchors are known in the artfor tying off sutures on the distal end of transosseous tunnels formaintaining tension. However, such conventional suture buttons are ofteninadequate and may lead to unintentional release of the applied tensionon the suture over time. This may cause the tissue to heal improperly,leading to discomfort and pain at the joint and potentially requiringadditional operations to reapply the necessary tension.

For example, some conventional suture buttons tend to position thesuture at the location passing into the distal tunnel opening in amanner that is axially misaligned with the tunnel opening. This maycause the suture to or rub or chafe against the edge or wall of thedrilled tunnel opening, thereby wearing on the suture and eventuallyloosening or breaking the suture tension over time. Additionally, someconventional suture buttons may cause tension loss because they positionthe suture material in between the button and the bone tissue at thedrilled tunnel opening, causing the bone to impinge on the suturematerial or to inadvertently torque the suture button leading to loss oftension.

What is needed, then, are improvements in suture button devices andmethods for surgical procedures.

BRIEF SUMMARY

The present disclosure generally provides a device and associatedmethods for anchoring a suture using a suture button during a surgicalprocedure. The device includes a suture button in some embodimentshaving an elongated shape with first and second tapered longitudinalends, and first and second lateral sides. The suture button alsoincludes an anterior surface and a posterior surface. A first side notchis defined in the first lateral side, and a second side notch is definedin the second lateral side. The first side notch opens into a firstsuture dock defined in the first side, and the second side notch opensinto a second suture dock defined in the second side. A center passageis defined through the suture button from the anterior surface to theposterior surface between the first and second suture docks. During use,a portion of a suture is retained in each of the first and second sidedocks, and the suture passes through the center passage into a drilledtransosseous tunnel.

Another object of the present disclosure is to provide a suture buttonfor use with knotless, self-cinching suture constructs for transosseoussuture tensioning during medial or lateral meniscal root repair surgicalprocedures.

A further object of the present disclosure is to provide a suture buttonfor use with conventional knotted suture constructs for transosseoussuture tensioning during medial or lateral meniscal root repair surgicalprocedures.

Yet another object of the present disclosure is to provide a suturebutton for use with suture constructs having an end with a fixed loop.

Another object of the present disclosure is to provide a suture buttonconfigured to secure a fixed loop suture end around the suture buttonusing a lateral girth hitch wherein a portion of the hitched sutureextends through a center passage in the suture button into a drilledtransosseous tunnel.

Another object of the present disclosure is to provide suture buttonhaving first and second tapered ends each shaped for accepting a loopedsuture construct such that a separate suture may be installed on eachtapered longitudinal end of the suture button.

A further object of the present disclosure is to provide a suture buttonhaving opposing tapered notches on each side of the suture button, eachtapered notch opening to a respective suture dock. Each notch is shapedwith a notch gap dimensioned to prevent each suture from backing out ofits respective suture dock.

Yet another object of the present disclosure is to provide a suturebutton having a center passage shaped to accommodate insertion of afixed loop suture end through the center passage for forming a lateralgirth hitch around the suture button.

Another object of the present disclosure is to provide a suture buttondimensioned to provide axial alignment between a suture hitched aroundthe suture button and the axial bore of a transosseous drill tunnel.

A further object of the present disclosure is to provide a suture buttondimensioned and shaped to prevent impingement of suture material by theedge or wall of a transosseous drill tunnel when the suture button isinstalled in contact with a patient's bone tissue.

Numerous other objects, features and advantages of the presentdisclosure will be readily apparent to those skilled in the art upon areading of the following disclosure when taken in conjunction with theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 2 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 3 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 4 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 5 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 6 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 7 illustrates a perspective view of an embodiment of a suturebutton having a suture installed thereon in accordance with the presentdisclosure.

FIG. 8 illustrates a perspective view of an embodiment of a suturebutton in accordance with the present disclosure.

FIG. 9 illustrates a top view of an embodiment of a suture button inaccordance with the present disclosure.

FIG. 10 illustrates a top view of an embodiment of a suture buttonshowing the outline of a transosseous tunnel opening in accordance withthe present disclosure.

FIG. 11 illustrates a perspective view of an embodiment of a suturebutton and a suture with a fixed loop positioned for installation on thesuture button in accordance with the present disclosure.

FIG. 12 illustrates a perspective view of an embodiment of a suturebutton and a suture with a conventional knotted suture.

FIG. 13 illustrates a perspective view of an embodiment of a suturebutton and a suture using a conventional suture knot to tighten thesuture construct in accordance with the present disclosure.

FIG. 14 illustrates a top view of an embodiment of a suture buttonshowing the outline of a transosseous tunnel opening in accordance withthe present disclosure

DETAILED DESCRIPTION

Referring now to the drawings, various views of embodiments of a suturebutton construct and associated suture are illustrated. In the drawings,not all reference numbers are included in each drawing, for the sake ofclarity. In addition, positional terms such as “upper,” “lower,” “side,”“top,” “bottom,” “vertical,” “horizontal” etc. refer to the apparatuswhen in the orientation shown in the drawings or similar orientations. Aperson of skill in the art will recognize that the apparatus can assumedifferent orientations when in use.

The present disclosure provides a suture button construct for use insurgical procedures. As shown in FIG. 1, suture button 10 is configuredto be utilized in surgical procedures requiring a surgeon to pull one ormore sutures tight, and to maintain a postoperative tension on thesuture within a desired tensile range. Suture button 10 may bespecifically configured in some embodiments to maintain suture tensionfollowing a repair of a root tear in a medial or lateral meniscus of ahuman knee using a drilled transosseous tunnel. Alternatively, suturebutton 10 may be used in numerous other procedures in other parts of thebody. Suture button 10 may also be utilized with various techniques andsuture constructs, including procedures using one or more knots adjacentthe suture button 10 to terminate the suture. Suture button 10 isconfigured for use with a knotless, self-cinching suture construct insome embodiments.

Suture button 10 provides a construct for securing and positioning atorn or damaged meniscal root during a meniscal root repair operation ata position near its natural anatomical position by maintaining tensionon a suture affixed to the root tissue. The tension is applied through adrilled transosseous tunnel. In such procedures, the suture button 10 ofthe present disclosure allows use of conventional suture constructs andtechniques as well as novel knotless, self-cinching suture constructsfor meniscal root repair. Thus, the suture button 10 of the presentdisclosure provides a universal suture button for meniscal root repairand other procedures that is readily interchangeable with a wide rangeof both conventional and novel suture constructs.

Referring to the drawings a suture button 10 of the present disclosureis shown for example in FIG. 1. Suture button 10 includes an elongatedbody 12 having a longitudinal length greater than its lateral width. Theelongated body 12 of suture button 10 includes a major longitudinal axisand a minor lateral axis. A first longitudinal end 14 is positioned at afirst end of the major longitudinal axis, and a second longitudinal end16 is positioned at the second end of the major longitudinal axisopposite the first longitudinal end 14. First and second ends 14, 16 areeach generally formed in a tapered shape sloping to a point at eachrespective longitudinal end. A first side 18, or first lateral edge, ispositioned along a first side of body 12, and a second side 20, orsecond lateral edge, is positioned along a second side of body 12opposite first side 18.

Suture button 10 includes a body 12 made of any suitable material formedical device, such as but not limited to a metal material such astitanium or a titanium alloy. In additional embodiments, suture button10 includes a body 12 constructed of a non-metal material such as butnot limited to a polyether ether ketone (PEEK) material, or anotherpolyester plastic material such as polylactic acid (PLLA), blendsthereof, or any other suitable material for constructing a suture buttonfor a surgical procedure.

Suture button 10 includes numerous features for securing one or moresutures to the suture button for anchoring a suture. Referring furtherto FIG. 1, suture button 10 includes a first side notch 22 defined infirst side 18. First side notch 22 provides a generally concaveindentation along first side 12 between first end 14 and second end 16.First side notch 22 includes a tapered recession providing a locationfor a suture to be received along the edge of first side 18.

Suture button 10 also includes a second side notch 24 defined in secondside 20, generally opposite first side notch 22. Second side notch 24provides a generally concave indentation along second side 20 of body 12between first end 14 and second end 16. Second side notch 24 includes atapered recession providing a location for a suture to be received alongthe edge of second side 20.

First side notch 22 is open at its innermost point to an interior firstsuture dock 26 defined in body 12 of suture button 10. First suture dock26 includes a length in the longitudinal direction greater than itslateral width and greater than the notch gap in first side notch 22,providing a space for one or more sutures to be received. First suturedock 26 includes a first suture dock interior wall having a concave “U”or “V” shape with a central indentation forming first suture dock seat40, shown in FIG. 1. The sloping profile of the interior wall of firstsuture dock 26 allows a suture residing in first suture dock 26 to becentrally seated at the first suture dock seat 40 when tensioned. Suchplacement allows the suture extending from suture button 10 into atransosseous drill tunnel to be axially aligned with the opening of thedrill tunnel and to prevent the suture from impinging on the wall oredge of the drill tunnel opening. This placement provides an advantageover some conventional suture buttons that position the suture aroundthe periphery of the suture button away from the centerline of thesuture button, which may cause the suture to become angled at its entryto the drill tunnel opening, resulting in undesirable contact betweenthe suture and the drill tunnel opening edge or wall and loss oftension.

Referring further to FIG. 1, second side notch 24 is open at itsinnermost point to an interior second suture dock 28 defined in body 12of suture button 10. Second suture dock 28 includes a length in thelongitudinal direction greater than its notch gap and its lateral width,providing a space for one or more sutures to be received. Second suturedock 28 includes a second suture dock interior wall having a “U” or “V”shape with a central indentation forming second suture dock seat 42. Thesloping profile of the interior wall of second suture dock 28 allows asuture residing in second suture dock 28 to be centrally seated at thesecond suture dock seat 42 when tensioned, as seen in FIG. 10. As notedabove with regard to first suture dock 26, the central alignment of asuture in second suture dock 28 at second suture dock seat 42 providesimproved positioning of the suture for entry into a transosseous drilltunnel opening when suture button 10 is installed against a patient'sbone.

In some embodiments, first notch 22 and first suture dock 26 aresymmetric about the major longitudinal axis of body 12 with second notch24 and second suture dock 28. This symmetry provides an identical sidenotch and suture dock on each side of suture button 10 and allows thedevice to readily accept one or more suture end loops around either endof suture button 10. This symmetry also allows each loop side to bereceived in its corresponding notch and to be centrally seated in itscorresponding suture dock seat in a similar orientation.

Referring further to FIG. 1, another feature of suture button 10includes a center passage 60 defined in body 12 between the anteriorside 102 and the opposing posterior side 104, seen in FIG. 7. Centerpassage 60 is defined entirely through suture button 10 to provide aspace for passage of one or more suture strands through suture button10. As seen in FIG. 1, center passage 60 is positioned at a midpointlaterally between first and second notches 22, 24. Additionally, centerpassage 60 is positioned at a midpoint between first and secondlongitudinal ends 14, 16. Center passage 60 includes straight side wallsand slightly curved concave end walls in some embodiments, as seen inFIG. 1.

Center passage includes a center passage length 62 and a center passagewidth 64, shown in FIG. 2. In some embodiments, center passage length 62is greater than center passage width 64. Center passage length 62 insome embodiments is between about six millimeters and about onemillimeter. In further embodiments, center passage length 62 is betweenabout 2.5 millimeters and about 4.5 millimeters. In additionalembodiments, center passage length 62 is about 3.5 millimeters. Centerpassage width 64 in some embodiments is between about 0.5 millimetersand about three millimeters. In further embodiments, center passagewidth 64 is between about one millimeter and about two millimeters. Inadditional embodiments, center passage width 64 is about 1.6millimeters. Center passage 60 includes a center passage length 62slightly longer than the longitudinal length of first and second suturedocks 62, 64. During use, one, two, three, four or more suture strandsmay pass through center passage 60 from either surface of suture button10 to the other.

Center passage 60 in some embodiments includes an aspect ratio of centerpassage length divided by center passage width greater than 1.0, forminga center passage having an elongated shape. The elongated shape ofcenter passage 60 provides a slit-shaped opening in some embodimentsallowing for easier passage of a fixed loop 72 on a suture end as seenin FIG. 11. During some procedures, it is desirable to install a suture70 having a fixed loop 72 onto suture button 10 by passing the fixedloop through center passage 60 and then looping the loop portion passedthrough the center passage back around the body 12, forming a lateralgirth hitch with loop 72 positioned around suture button 10 as seen inFIG. 7. To initiate the installation of the fixed loop 72 onto suturebutton 10, the loop must be first inserted into center passage 60. Afixed loop 72 naturally has a flattened profile having a width muchgreater than its thickness. Using a conventional center passage having auniform circular hole makes it difficult to insert the unique shape ofthe fixed loop through the body of the suture button 10. The presentdisclosure addresses this difficulty by providing a suture button 10having a center passage 60 including a center passage aspect ratio ofcenter passage length 62 divided by center passage width 64 betweenabout one and about ten. In some embodiments, the center passage aspectratio is between about one and about three. In additional embodiments,the center passage aspect ratio is between about two and about 2.4. Byproviding a center passage aspect ratio greater than about one in someembodiments, a fixed loop 72, as shown in FIG. 11, may be more easilyinserted through center passage 60 on suture button 10.

Referring further to FIG. 2, suture button 10 includes a suture buttonlength 48 and a suture button width 50. Suture button length 48 isdefined as the longitudinal distance between first end 14 and second end16. Suture button length 48 includes any suitable length to provide ananchor for retaining one or more suture strands during and/or after asurgical procedure. In some embodiments, suture button length 48 isbetween about five and about twenty millimeters. In further embodiments,suture button length 48 is between about ten and about fifteenmillimeters. In additional embodiments, suture button length is abouttwelve millimeters. Similarly, suture button width 50 is defined as thedistance between the lateral distance between the widest points onsuture button 10. In some embodiments, suture button width 50 is definedbetween the outermost point on first side 18 and the outermost point onsecond side 20. Suture button width 50 includes any distance suitablefor providing an anchor to retain one or more suture button strandsduring and/or after a surgical procedure. Suture button width 50 in someembodiments is between about three millimeters and about twentymillimeters. In further embodiments, suture button width 50 is betweenabout five millimeters and about ten millimeters. In additionalembodiments, suture button width 50 is about seven millimeters.

Referring further to FIG. 2, first notch 22 provides a passage for oneor more suture strands into first suture dock 26. First notch 22 tapersdown to form a central gap having a notch gap spacing 46. Notch gapspacing 46 includes the minimum gap spacing between the opposingprojections protruding from body 12 to form the narrowest point in firstnotch 22 at the passage into first suture dock 26. Notch gap spacing 46is dimensioned in some embodiments to correspond to a mean diameter of asuture strand to be used in a surgical procedure.

For example, as shown in FIGS. 3-5, a suture 70 may be positioned forinsertion into the first suture dock 26 on suture button 10. Suture 70may include a free strand of a suture material or may include a sideportion of a loop of suture material. Suture 70 is initially receivedinto first side notch 22. First side notch 22 includes a first ramp 52and a second ramp 54. First and second ramps 52, 54 form a concave,tapered profile of body 12 along the region of first notch 22. The firstand second ramps slope inwardly toward each other in a “V” shape,funneling the suture 70 toward the notch gap, as shown in FIG. 3 andFIG. 4. Notch gap spacing 46 is dimensioned to be slightly narrower thanthe mean diameter of the suture 70, thereby causing suture 70 to becomeslightly radially compressed, as seen in FIG. 4, as suture 70 passesfrom first side notch 22 into first suture dock 26. When suture 70 exitsthe narrow gap, the suture may expand radially back to its uncompresseddiameter as it resides in the first suture dock 26. As further tensionis applied to the suture 70, the additional slope of the interior wallof first suture dock 26 causes the suture 70 to become seated along thecenter of the first suture dock 26 at the first suture dock seat 40.

Similarly, second notch 24 includes third and fourth ramps 56, 58. Thirdand fourth ramps 56, 58 form a concave, tapered profile of body 12 alongthe region of second notch 24. The third and fourth ramps slope inwardlytoward each other in a “V” shape, funneling any suture entering secondnotch 26 toward the notch gap. Second notch 24 includes a similar notchgap spacing 46 dimensioned to be slightly more narrow than the meandiameter of a suture to be used, thereby causing the suture to becomeslightly radially compressed when the suture passes from second notch 24to second suture dock 28. When the suture exits the narrow gap, thesuture may expand radially back to its uncompressed diameter as itresides in the second suture dock 28. As further tension is applied tothe suture while it resides in second suture dock 28, the additionalslope of the interior wall of second suture dock 28 causes the suture tobecome seated along the centerline of the second suture dock 28 at thesecond suture dock seat 42.

In some embodiments, notch gap spacing 46 on both first notch 22 andsecond notch 24 is configured to be slightly smaller than the meandiameter of a desired suture material, including either monofilamentsuture material or braided suture material. For example, notch gapspacing 46 in some embodiments is about 0.25 millimeters, and isconfigured for use with a suture material having a mean diameter greaterthan about 0.25 millimeters such that the suture must be slightlyradially compressed to pass from first or second notch 22, 24 into firstor second suture dock 26, 28, respectively.

As shown in FIG. 5, first notch 22 and second notch 24 each include asubstantially flat outer suture dock wall, forming right angles at theopenings from each respective suture dock 26, 28 outwardly away from thesuture body. Because each outer suture dock wall is substantially flatin some embodiments, and because the notch gap spacing 46 is slightlyless than the mean diameter of a suture being used, each suture isretained within its corresponding suture dock and is prevented frombeing able to inadvertently back out of the suture dock through thenotch gap. This design further helps retain each suture segment in itscorresponding suture dock after initial entry into the suture dock.

In some embodiments, suture button 10 is configured to be attached to asuture 70 including a fixed loop 72 at its end, as shown in FIGS. 7, 8,9 and 11. More specifically, a fixed loop 72 may be passed throughcenter passage 60 and then slid over either first end 14 or second end16 to form a girth hitch around the body 12 of suture button 10. Asnoted above, one feature allowing use with a fixed loop is the centerpassage 60 having an aspect ratio greater than 1.0 to allow easierinsertion of the fixed loop. Additional other features provide improvedease of use with a fixed loop girth hitch attachment. For example, asshown in FIG. 6, first end 14 has a tapered shape sloping toward firstend point 80, and second end 16 has a tapered shape sloping towardsecond end point 90. Additionally, first side 18 includes a first ramp92 sloping toward first end point 80 and a second ramp 94 sloping towardsecond end point 90. Similarly, second side 20 includes a third ramp 96sloping toward first end point 80 opposing first ramp 92, and secondside 20 also includes a fourth ramp 98 sloping toward second end point90 opposing second ramp 94. Thus, each longitudinal end of suture button10 includes a generally tapered shape to ease positioning of the loopportion back onto either longitudinal end after the loop has passedthrough center passage 60.

As shown further in FIG. 6, first side 18 includes a first lateral apex82 and a second lateral apex 84. Second side 20 includes a third lateralapex 86 and a fourth lateral apex 88. First lateral apex 82 is oppositethird lateral apex 86 forming a first lateral apex pair on the left sideof the suture button 10, and second lateral apex 84 is opposite fourthlateral apex 88 forming a second lateral apex pair on the right side ofthe suture button 10. First and second lateral apex pairs each form thewidest points on suture button 10 in some embodiments, as seen in FIG.6. For example, the first lateral apex pair defines the outermostlateral dimension on suture button 10, and is equal to body width 50 insome embodiments. The second lateral apex pair similarly defines thesame lateral dimension as the first lateral apex pair in someembodiments. In other embodiments, first and second lateral apex pairsmay form different dimensions to accommodate different loop sizes oneach longitudinal end of suture button 10.

The lateral sides of suture button 10 between neighboring apex pairs onthe same side begins to slope back inwardly toward the center of body12. For example, between first lateral apex 82 and second lateral apex84, first ramp 52 slopes inwardly toward first suture dock 26 as seen inFIG. 6. Similarly, between first lateral apex 82 and second lateral apex84, second ramp 54 slopes inwardly toward first suture dock 26. On theopposite side of suture button 10, between third lateral apex 86 andfourth lateral apex 88, third ramp 56 and fourth ramp 58 both slopeinwardly toward second suture dock 26. Thus, when a fixed loop 72 isslid through center passage 60 and back onto either first longitudinalend 14 or second longitudinal end 16, the loop will first slide overeither first or second lateral apex pair, respectively, and then slidealong first and third ramps 52, 56 or second and fourth ramps 54, 58toward a suture dock.

Referring to FIG. 9, an example of a fixed loop being slid into place ina girth hitch configuration on suture button 10 is shown. A first loopside 72 a slides into first notch 22, and a second loop side 72 b slidesinto second notch 24. In the example shown in FIG. 9, the fixed loop 72is being slid over the second longitudinal end 16 after being insertedthrough the center passage. Alternatively, the fixed loop could be slidover the first longitudinal end 14 after being inserted through thecenter passage.

Another example of a fixed loop installed on a suture button 10 using agirth hitch attachment is shown in FIG. 7 and FIG. 8. As shown in FIG.7, a suture 70 includes a loop 72 first inserted downwardly throughcenter passage 60 from the posterior side 104 of suture button 10. Theloop is then positioned back around a longitudinal end of the suturebutton 10 forming a girth hitch around the body of the suture button 10.In the embodiment shown in FIG. 7 and FIG. 8, the fixed loop was slidback over the first longitudinal end 14. A first loop side 72 a isreceived in first suture dock 26, and a second loop side 72 b isreceived in second suture dock 28. When tension is applied to the suture70 the hitched loop around suture button 10 becomes tighter, drawingfirst loop side 72 a and second loop side 72 b in even more tightlyagainst suture button 10. This causes first loop side 72 a to be seatedin the “U” shaped or “V” shaped first suture dock seat 40, and causesthe second loop side 72 b to be seated in the “U” shaped or “V” shapedsecond suture dock seat 42, shown in FIG. 10.

As shown in FIG. 7 and FIG. 8, during installation, first ramp 52 andsecond ramp 54 in first notch 22 cause first loop side 72 a to befunneled toward the centerline of the suture button 10. First loop side72 a then becomes slightly radially compressed as it passes through thenotch gap in first notch 22. First loop side 72 a then snaps back to itsoriginal uncompressed size as it enters first suture dock 26. Similarly,third ramp 56 and fourth ramp 58 in second notch 24 cause second loopside 72 b to be funneled toward the centerline of the suture button 10.Second loop side 72 b then becomes slightly radially compressed as itpasses through the notch gap in second notch 24. Second loop side 72 bthen snaps back to its original compressed size as it enters secondsuture dock 28.

As shown in FIG. 7, suture button 10 includes a body thickness 66 insome embodiments. Body thickness 66 is the distance between anteriorside 102, shown in FIG. 8, and posterior side 104, shown in FIG. 7.Posterior side 104 is generally defined as the side of suture button 10that faces the bone and is placed adjacent the drill tunnel opening.Anterior side 102 is generally defined as the side of suture button 10that faces away from the drill tunnel opening when installed. In someembodiments, body thickness 66 is between about 0.5 millimeters andabout four millimeters. In further embodiments, body thickness 66 isbetween about one millimeter and about two millimeters. In additionalembodiments, body thickness 66 is about 1.5 millimeters. Body thickness66 may include any suitable material thickness to provide stability andrigidity for tensioning a suture. In some embodiments, suture body 10includes a uniform body thickness. In further embodiments, suture body10 includes a non-uniform body thickness across body 12. In someapplications, it is desirable to provide a body thickness 66 that allowssuture button 10 to deflect slightly along its major longitudinal axistoward the drill tunnel opening to further maintain tension and to keepthe button at a desired location against the bone.

Suture button 10 may be used in numerous types of procedures. In someembodiments, suture button 10 is used with a knotless suture constructas shown for example in FIG. 8 and FIG. 9. The knotless suture constructincludes a suture 70 having a fixed loop 72 at one end. The fixed loop72 is affixed around the body of the suture button 10 in a girth hitch,as previously described. Suture 70 exits the central passage 60 onsuture button 10 and extends toward tissue to be engaged. For example,as shown in FIG. 9, suture 70 extends from button 10 toward a knee 210.Suture 70 a enters a lower opening 236 of a transosseous drill tunnel238 through the patient's tibia 212 and knee 210. Suture 70 extendsthrough drill tunnel 238 to the site of a meniscal root tear in thisembodiment. The suture 70 b passes through the tissue or another joiningstructure at the root tear site and then exits the lower opening 236. Aknotless suture construct includes a self-cinching sleeve 140 in someembodiments. Sleeve 140 is formed in suture 70 near fixed loop 72between suture button 10 and lower opening 236. Free suture end 136extending back toward suture button 10 from suture 70 b passes freelythrough sleeve 140. Free suture end 136, shown in FIG. 8 after passingthrough sleeve 140, may then be inserted through center passage 60, asshown in FIG. 9. The free suture end 136 is then pulled relative tosuture button 10, causing the suture button 10 to be drawn closer tolower opening 236 as suture 70 slides through the tissue or joiningstructure at the repair site. Once the free suture end 136 is drawntight, suture button is pulled directly against the bone in knee 210,and sleeve 140 is cinched tightly against suture 70 b causing a grippingeffect that prevents the applied tension from being released. Fixed loop72 formed in a girth hitch around suture button 72 forms a rigid anchoragainst which tension may be pulled. Suture button 10 will then maintainits position, held in place against the bone using the tension appliedby suture 70. The tag portion of free suture end 136 may then be trimmedafter a desired tension is applied.

When suture button 10 is pulled against the bone such that suture button10 is adjacent lower opening 236 on tunnel 238, it is generallydesirable that the suture material not be impinged upon the edge oflower opening 236. Such impingement may prevent a surgeon from beingable to pull a desirable tension on the suture 70. Additionally, suchimpingement may cause inadvertent wear or stress on the suture, leadingto a weakening or failure of the suture material.

Another aspect of the present disclosure provides a suture button forsurgical procedures configured to provide axial alignment of the suture70 exiting center passage 60 with the axial bore of tunnel 238. Becausethe hitched portion of suture 70 extending toward tunnel 238 includesthe section extending from center passage 60, the suture 70 enteringlower opening 236 extends from suture button 10 at a position very nearthe lateral and longitudinal center of suture button 10, as shown inFIG. 7. Thus, when suture button 10 is positioned adjacent the bonestructure at the lower opening 236 after suture 70 is pulled tight, theportion of suture 70 exiting center opening 60 and entering tunnel 238is axially aligned near the center of tunnel 238, and suture button 10is centered over lower opening 236.

Additionally, in some embodiments, suture button 10 is dimensioned suchthat first loop side 72 a housed in first side dock 26 and second loopside 72 b housed in second side dock 28 when fully seated are laterallyspaced such that neither contacts the bone wall adjacent lower opening236. For example, as seen in FIG. 10, suture button 10 is dimensionedsuch that a bridge width 68 is defined as the narrowest distance betweenfirst dock seat 40 and second dock seat 42. The bridge width 68 plus twotimes the suture mean diameter is less than tunnel diameter 240. Assuch, when a fixed loop is installed around suture button 10 such that afirst loop side 72 a is retained in first dock seat 40 and a second loopside 72 b is retained in second dock seat 42, the outer lateral distancebetween first loop side 72 a and second loop side 72 b is less thantunnel diameter 240. This configuration allows the suture button 10 tobe installed such that no portion of the suture material is impinged bythe bone tissue adjacent lower opening 236. This configuration allows astronger attachment between suture button 10 and the bone structureadjacent lower opening 236 without any intermediate suture materialbeing pinched between suture button 10 and the bone surface. In someembodiments, to ensure clearance between the suture material and thelower opening 236, suture body includes a notch distance 74 defined asthe distance between the outer wall on first side dock 26 and the outerwall on second side dock 28. Notch distance 74 is equal to drill tunneldiameter in some embodiments to provide adequate clearance. Inadditional embodiments, the ratio of tunnel diameter 240 to notchdistance 74 is between about 0.9 and about 2.0 to provide adequateclearance. In further embodiments, the ratio of tunnel diameter 240 tonotch distance 74 is about 1.0 to provide adequate clearance. In furtherembodiments, the ratio of tunnel diameter 240 to bridge width 68 isbetween about 1.0 and about 2.0 to provide adequate clearance.

Referring further to the drawings, FIGS. 12-14 illustrate an embodimentof a suture button 10 of the present disclosure positioned for use witha conventional knotted suture construct. When used with conventionalknotted suture constructs and knotted suture tightening techniques,suture button 10 provides advantages over traditional suture buttonsknown in the art for several reasons. These advantages include sutureself-centering and “locking” in place in first and second suture docks26, 28 via first and second notches 22, 24, and also axial suturealignment with the drill tunnel when tightened to prevent impingement ofthe suture against the bone at the drill tunnel opening.

For example first and second notches 22, 24 allow suture material toslide into first and second docks 26, 28, and also prevent sutures frominadvertently backing out of first and second suture docks 26, 28,respectively during tightening. For example, first and second sutures 70a, 70 b extend from a transosseous drill tunnel opening toward suturebutton 10. First suture 70 a includes a first free tag end slidlaterally through first notch 22 into first suture dock 26. First suture70 a is held in first suture dock 26 and is prevented from easilybacking out through first notch 22 by first and second ramps 52, 54.Similarly, second suture 70 b includes a second free tag end slidlaterally through second notch 24 into second suture dock 28. Secondsuture 70 b is held in second suture dock 28 and is prevented fromeasily backing out through second notch 24 by third and fourth ramps 56,58.

As shown in FIG. 12, suture button 10 is positioned with its posteriorside 104 facing toward the distal transosseous drill tunnel opening andwith its anterior side 102 facing away from the opening. A surgeon mayhold the free tag ends of first and second sutures 70 a, 70 b and freelyslide suture button 10 toward the distal transosseous opening 236 untilthe posterior side 104 of suture button 10 is in contact with the bonetissue.

Once suture button 10 in place, or while suture button 10 is beingadvanced toward the desired location against the bone, the surgeon formsone or more knots on the anterior side 102 of suture button 10 using thefirst and second free tag ends of first and second sutures 70 a, 70 b.For example, as shown in FIG. 13, a single-wrap throw may be formedbetween first and second sutures 70 a, 70 b on anterior side 102 ofsuture button 10. Each tag end may be pulled tight to further advancesuture button 10 toward the bone. Alternatively, a double-wrap firstthrow may be formed on anterior side 102 of suture button 10. Once asuitable first knot 76 such as a tight single-wrap or double-wrap firstthrow is established, numerous types of suture knots may be formed onanterior side 102 of suture button 10 to provide a desired connectionbetween the first and second free tag ends of first and second sutures70 a, 70 b. Such knots may include but are not limited to a square knot,a granny knot, a surgeon's knot, a slip knot, or any other suitablesuture knot or combination of suture knots to secure first and secondsutures 70 a, 70 b together on anterior side 102 of suture button 10.

Another aspect of suture button 10 providing an advantage overconventional suture buttons in some embodiments relates to suturealignment with distal transosseous drill tunnel opening 236. As shown inFIG. 14, suture button 10 is dimensioned such that first and secondsutures 70 a, 70 b are laterally aligned with distal transosseous drilltunnel opening 236 in some embodiments such that neither first suture 70a nor second suture 70 b rubs against the drill tunnel opening surfacewhen each suture is fully seated in its corresponding suture dock. Thisconfiguration also provides a self-centering of suture button 10relative to the drill tunnel opening as the suture is tightened. In somesuch embodiments, notch distance 74 is less than drill tunnel openingdiameter 240, providing lateral clearance for first and second sutures70 a, 70 b as they pass from the suture button 10 into the drill tunnel.This configuration provides an advantage over many conventional suturebuttons that fail to include a geometry allowing axial alignment andlateral clearance of first and second sutures 70 a, 70 b as they passinto the drill tunnel opening, thereby causing the suture button toundesirably impinge on the suture material adjacent the drill tunnelopening.

Thus, although there have been described particular embodiments of thepresent invention of a new and useful Suture Button for SurgicalProcedure, it is not intended that such references be construed aslimitations upon the scope of this invention except as set forth in thefollowing claims.

What is claimed is:
 1. A suture button apparatus, comprising: a bodyhaving a major longitudinal axis and a first longitudinal end, a secondlongitudinal end, a first lateral side, a second lateral side, ananterior surface, and a posterior surface; a first suture dock definedin the first lateral side; a second suture dock defined in the secondlateral side; a center passage defined through the body from theanterior surface to the posterior surface, the center passage positionedat a midpoint laterally between the first and second suture docks,wherein the center passage is also positioned at a midpoint betweenfirst and second longitudinal ends; a first tapered notch defined in thefirst lateral side open to the first suture dock, the first taperednotch including a substantially flat outer suture dock wall; and asecond tapered notch defined in the second lateral side open to thesecond suture dock, wherein the first tapered notch and first suturedock are symmetric about the major longitudinal axis of the body withthe second tapered notch and the second suture dock, respectively. 2.The apparatus of claim 1, wherein the first longitudinal end is taperedtoward a first longitudinal point.
 3. The apparatus of claim 2, whereinthe second longitudinal end is tapered toward a second longitudinalpoint opposite the first longitudinal point.
 4. The apparatus of claim1, wherein the body has a longitudinal length and a lateral width, andwherein the longitudinal length is greater than the lateral width. 5.The apparatus of claim 1, wherein the first side notch defines a firstnotch gap having a first notch gap spacing.
 6. The apparatus of claim 5,wherein the first suture dock includes a longitudinal dock length in alongitudinal direction and a lateral dock width in a lateral direction,and wherein the longitudinal dock length is greater than lateral dockwidth and greater than the first notch gap spacing.
 7. The apparatus ofclaim 6, wherein the center passage includes a center passage length anda center passage width, and wherein the center passage length is greaterthan the center passage width.
 8. The apparatus of claim 7, wherein thecenter passage length is greater than the longitudinal dock length. 9.The apparatus of claim 1, wherein the first lateral side includes afirst lateral apex and a second lateral apex, and wherein the secondlateral side includes a third lateral apex and a fourth lateral apex.10. The apparatus of claim 9, wherein the first lateral apex is oppositethe third lateral apex forming a first apex pair, and wherein the secondlateral apex is opposite the fourth lateral apex forming a second apexpair.
 11. The apparatus of claim 10, wherein the first apex pair and thesecond apex pair define a widest lateral dimension of the body.
 12. Theapparatus of claim 11, wherein the first lateral side between the firstlateral apex and the second lateral apex slope inwardly toward the firstsuture dock, and wherein the second lateral side between the thirdlateral apex and the fourth lateral apex slope inwardly toward thesecond suture dock.